Can a pharmacist recommend medicines

Medical products (drugs, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor’s prescription. Recommended reading: “Why can’t you take medications without a doctor’s prescription?”.

Medicine and pharmaceuticals are closely and directly related to each other. They began to develop in ancient times almost simultaneously, and still continue to interact. Today it is impossible to imagine how doctors would treat patients without drugs. Doctor-pharmacy-recovery is a natural chain that everyone who wants to regain their health goes through. But, as practice shows, many patients skip the consultation of a specialist in a polyclinic or hospital, turning directly to a pharmacist. This is explained by the availability of pharmacies – in any settlement they are almost at every step. But the main reason is that people trust pharmacists, because such specialists also have a medical background. But in all cases, pharmacy workers have the right to recommend medicines.

Pharmaceutical care is the basis of the work of a pharmacist

Having appeared at the end of the 20th century, the Internet has brought into our lives the ability to access almost any information. At the same time, the World Wide Web has become the cause of such a problem as diagnosing via the Internet and self-treatment. Looking for symptoms in themselves and comparing them with those described on web resources, many patients only exacerbate the situation.

In light of these trends, the role of the pharmacist is very important. This specialist not only can, but should, provide advice to self-diagnosed patients as part of the pharmaceutical care of over-the-counter drugs. His responsibilities, as recommended by the World Health Assembly under the resolution “The role of the pharmacist in the implementation of the revised WHO drug strategy”, include:

• determine which symptoms the patient is going to treat with the drug;
• find out if the symptoms are signs of a serious illness and if urgent medical advice is required;
• choose the optimal dosage form, explain the rules for taking the medicine, warn about possible side effects;
• tell about the storage conditions of the drug, because the wrong temperature regime causes the loss of its therapeutic effect ^[1].

As practice shows, most patients trust pharmacists, so they easily enter into a dialogue. Often the initiative in the conversation belongs to the pharmacy worker. By asking a few questions, such a specialist can determine whether self-medication is safe. With threatening symptoms, he should refer the pharmacy customer to a doctor.

What medicines can a pharmacist recommend?

Despite the fact that pharmacy is a medical specialty, specialists in this industry do not have such a wide right to prescribe and recommend medicines.

In practice, there are different situations, but a pharmacist should not offer prescription drugs to a pharmacy customer. Their appointment is the exclusive competence of the doctor. Almost 70% of all drugs belong to such prescription drugs.

Antibiotics

Such funds have always had to be dispensed by prescription, but not all pharmacies complied with this rule. The Ministry of Health of Ukraine solved the problem radically – from August 1, 2022, it is possible to purchase antibacterial agents only by prescription ^[2]. In Russia, the sale of antibiotics without a prescription has been strictly prohibited since 2017, although their sale was already regulated in 2005. ^[3]. In Belarus, there are several antimicrobial drugs that are sold without a prescription, so a pharmacist can recommend them. They are used to treat respiratory tract infections, prevent tick-borne borreliosis. These drugs include amoxicillin and its combinations with clavulanic acid, doxycycline, ampicillin ^[4]. But we are talking only about oral dosage forms. Belarusian pharmacists do not have the right to recommend injectable antibiotics, since they are dispensed by prescription.

In Azerbaijan, Kazakhstan, Armenia, pharmacists also should not recommend antibiotics, because they are prescription drugs. But in practice, even a child can buy them in pharmacies of these countries. According to WHO data, Armenia ranks first in terms of the number of patients using second-line antibiotics. And the reason for this is the availability of such drugs.

Analgesics

First of all, the pharmacist cannot recommend narcotic analgesics, as well as strong painkillers, such as codeine-containing combination preparations. All these are prescription drugs, so their appointment is only in the competence of the doctor. And this is logical, because if the patient is in severe pain, he must definitely consult a doctor.

At the same time, such painkillers and antipyretics as ibuprofen, paracetamol, analgin or drotaverine, the pharmacist can safely recommend. This will allow the pharmacy customer to self-medicate a mild cold or pain that is not an emergency. But it is important to understand that this only applies to tablets, syrups, powders for preparing a drink or suspension. All injectable forms of painkillers cannot be recommended by pharmacists.

Hormonal preparations

A pharmacist cannot recommend hormonal drugs, regardless of their type and purpose. And this is despite the fact that there are funds from this group that are available without a prescription. For example, oral contraceptives, DMPA, contraceptive patches and vaginal rings can be freely purchased at the pharmacy. But, given that pharmaceutical education does not provide in-depth knowledge in gynecology, the recommendations of such funds are impossible.

The remaining groups of hormonal drugs, especially their injectable forms, are dispensed strictly by prescription, so their appointment by a pharmacist is simply impossible.

Similarly, pharmacy staff cannot recommend psychotropic, potent, antiepileptic drugs, as well as all drugs intended for intramuscular, intravenous administration.

Uncontrolled prescription drug prescriptions by pharmacists can harm health and damage the pharmacy itself. In the CIS countries, such dispensing of drugs is punishable by:

• in Russia, a pharmacist who recommends and dispenses a prescription drug without a doctor’s prescription will be fined. A fine can also be imposed on the pharmacy itself or even suspend its activities for up to 90 days. ^[5];
• in Ukraine, this provides for administrative liability and fines ranging from 850 to 1700 hryvnias. By the way, there is also a punishment for the recommendation and dispensing of prescription drugs to children. The fine in this case can be increased to 3400 hryvnia. ^[6];
• By 2023, a law will come into force in Armenia that will tighten the responsibility for prescribing prescription drugs by doctors. So far, the situation is deplorable, because most drugs in this country are freely sold in pharmacies, and pharmacists themselves often recommend them. ^[7];
• in Kazakhstan, pharmacist dispensing and recommendations are strictly controlled. Self-treatment of a patient and the prescription of prescription drugs by a pharmacy worker will be expensive: he faces a fine of 70 to 100 MCI. The organization itself can pay from 130 to 1000 MCI ^[8].

When can a pharmacist recommend medicines?

However, there are still a few situations in which a pharmacist can make recommendations despite a prescription. It is worth taking apart each of them.

Situation 1: the dosage form of the prescription drug is not selected for age

Quite often, doctors give children half or a quarter of a tablet of a drug intended for adults. If the pharmacist encounters such a prescription, he may recommend a dosage form of this remedy, specially produced for children. For example, the antibiotic Augmentin based on amoxicillin is available in tablets and in suspension for preparing a solution. If a small patient is less than 12 years old, the manufacturer does not recommend the use of tablets. In such cases, it is safer to use the suspension. But at the same time, the pharmacist must definitely find out the necessary dosage, taking into account the prescriptions of the doctor.

Situation 2: the patient has contraindications to taking the drug

If, in a dialogue with a client, a pharmacist finds out that the patient has contraindications to a particular drug, he can recommend him, after consulting with a doctor, to choose a drug from the same group or with the same properties, only safer in a particular case. Thus, the patient will receive both effective treatment and prevent other health complications.

Situation 3: the prescription is written for the active substance

In this case, the pharmacist not only can, but should recommend drugs. Moreover, he has the right to offer several drugs with one active substance at once, but from different manufacturers. For example, a cardiologist prescribed enalapril-based pills for high blood pressure to a patient. The pharmacist can recommend him Enap, Berlipril, Renipril, as well as any domestic analogues. And the client himself will choose which medicine suits him according to the budget or other parameters.

Situation 4: the drug is temporarily out of stock in pharmacies

Medicines can disappear from all pharmacies at the same time in several cases:

• at the end of registration in the country, if they are imported;
• when funds are quarantined and require additional quality and compliance checks;
• there are problems with deliveries throughout the locality.

In such a situation, the pharmacist may recommend a similar remedy, but the patient must still see a doctor to get a new prescription.

Outlook and possible changes

The debate about whether a pharmacist can recommend medicines has been going on for years. In Russia, this issue is already being raised at the state level. Thus, the Ministry of Labor and Social Protection of the Russian Federation has developed a draft order “On approval of the professional standard “Pharmacist”, which is being considered by the Ministry of Health ^[9]. It proposes to formally allow pharmacists to recommend medicines. The exact result is still unpredictable, but in any case it is important to remember: a pharmacy worker has a medical education, but he does not study therapy, gynecology, cardiology and other areas of medicine as deeply as future doctors. Perhaps it is better for these two professions to work in tandem, rather than compete with each other?

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